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SYB 1
Erin Gundersen MS IV
Breast Cancer
Main Types
In Situ- tumor cells confined to ducts and lobules with no invasion Ductal
• Calcifications• Palpable mass
Lobular• Not palpable, no mammographic appearance• Incidental finding• Increase risk of invasive cancer
Main Types
Invasive Carcinoma- invade breast stroma, can spread or metastasize
Infiltrating ductal — 76 percent Invasive lobular — 8 percent Ductal/lobular — 7 percent Mucinous (colloid) — 2.4 percent Tubular — 1.5 percent Medullary — 1.2 percent Papillary — 1 percent
Mammography
Spiculated soft tissue mass Most specific- 90% are invasive CA
Clustered microcalcifications- 0.1 to 1 mm in diameter, and numbering more than 4 to 5 per cubic centimeter Intraductal necrotic tumor DCIS Mucin-secreting tumors Benign- vascular, skin, rim-like, coarse, smooth
round or oval
BIRADS diagnostic categories
0- need additional testing 1- negative 2- benign finding 3- probably benign finding 4- suspicious 5- highly suggestive of malignancy 6- biopsy proven carcinoma
Limitations of Mammography
Technique and positioning error Density of breast tissue Error in reading Slow growing tumor
Ultrasound
Uses Cystic from solid lesions U/S guided biopsy
Limitations Not see microcalcification Miss part of breast tissue
Applications of MRI
Screening tool in patients with genetic or familial predisposition
Staging of breast cancer Determination of recurrent/residual
disease Determination of occult disease
Limitations of MRI
Enhancement during luteal phase Enhancement with hormone therapy Difficulty distinguishing benign from
malignant May miss DCIS or invasive lobular
Conclusion
Mammography, ultrasound, and MRI can be used to evaluate breast cancer
Each modality has advantages and limitations
MRI is an evolving diagnostic tool
References Laura J Esserman, MD, MBA. "Diagnostic evaluation and initial staging work-up of
women with suspected breast cancer." Uptodate. 31 May 2008. 6 Oct. 2008 <http://www.uptodateonline.com/online/content/topic.do?topickey=breastcn/13029&selectedtitle=1~5&source=search_result#1>.
Mieke Kriege, M.Sc., Cecile T.M. Brekelmans, M.D., Ph.D., Carla Boetes, M.D., Ph.D., Peter E. Besnard, M.D., Ph.D., Harmine M. Zonderland, M.D., Ph.D., Inge Marie Obdeijn, M.D., Radu A. Manoliu, M.D., Ph.D., Theo Kok, M.D., Ph.D. "Efficacy of MRI and Mammography for Breast-Cancer Screening in Women with a Familial or Genetic Predisposition." Nejm 351 (2004): 427-37.
Shinil K. Shah, BS, Shiwan K. Shah, BS, and Kathleen V. Greatrex, MD. "Current Role of Magnetic Resonance Imaging in Breast Cancer: A Primer for the Primary Care Physician." JABFM 18 (2005): 478-90.